Field Reimbursement Manager- North OC, CA
About The Position
The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement, supporting the Bone Health business unit by executing the collaborative territory strategic plan. The FRM helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs, and resolves patient-level reimbursement issues involving protected health information. The territory includes West Covina, Torrance, Santa Ana, Anaheim, the Inland Empire, and Palm Springs, California. Relocation is not included. The FRM acts as an extension of the HUB and provides live, one-on-one coverage support throughout the reimbursement journey, from physician orders through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers on public and private payer coverage, benefit design, formulary criteria, utilization management, insurance procedures, benefits investigations, and patient assistance options. It coordinates access issues with the HUB and other partners, shares payer changes with stakeholders, and collaborates across departments to resolve reimbursement challenges. The role works remotely from a home office, with customer appointments in the territory two days per week and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. The position may involve extended periods of sitting and keyboard work.
Requirements
- Doctorate degree; or a master's degree and 3 years of customer service and/or leadership experience; or a bachelor's degree and 5 years; or an associate's degree and 10 years; or a high school diploma/GED and 12 years.
- Experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation. This experience may run concurrently with the required technical experience.
- At least 2 years of experience in a public or private third-party access arena or the pharmaceutical industry in managed care, clinical support, and/or sales.
- Strong medical reimbursement experience and/or knowledge of Specialty Pharmacy and Buy & Bill.
- Proven presentation and facilitation skills.
- Strong written and oral communication skills.
- Organizational skills and project management experience, including the ability to manage multiple projects.
- Computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings.
- Healthcare industry experience, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers.
- Experience with HUBs and in-depth knowledge of billing, coding, and appeals issues across physician types.
- Strong collaboration skills and ability to lead cross-functional partner meetings.
- Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region.
- Live in the geography or within 10 miles of the geography border.
- Must have a valid driver's license and a clean driving record.
- Must be able to travel up to 40% by automobile or plane.
Nice To Haves
- Bachelor's degree in business, healthcare, or a related field.
- 6 years of experience with specialty/biologic self-injectable products (pharmacy benefit) or physician-administered products (buy and bill/medical benefit).
- Advanced knowledge of medical insurance terminology.
- Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part B for buy-and-bill products and Part D for pharmacy products.
- Ability to manage ambiguity and solve problems.
- Ability to manage expenses within allocated budgets.
Responsibilities
- Manage defined accounts in a specified geographic region for Patient Access and Reimbursement.
- Support products by executing the collaborative territory strategic plan.
- Act as an extension of the HUB by providing live, one-on-one coverage support.
- Assist healthcare providers from physician order through reimbursement, including payer prior authorization, appeals, denials, and related requirements and forms.
- Review patient-specific information when a site requests assistance with issues or coverage challenges.
- Educate and update healthcare providers on private and public payer coverage and changes affecting patient access.
- Coordinate access and reimbursement issues with relevant partners, including the HUB.
- Explain product coverage under commercial, Medicare, and Medicaid benefit designs.
- Serve as a payer expert for the defined geography and promptly communicate payer changes to stakeholders.
- Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorizations, appeals, and claims resolution.
- Educate offices using approved materials.
- Review patient insurance benefit options and alternative funding or financial assistance programs.
- Collaborate with other departments to resolve reimbursement issues.
Benefits
- Retirement and Savings Plan with company contributions
- Group medical coverage
- Dental coverage
- Vision coverage
- Life insurance
- Disability insurance
- Flexible spending accounts
- Discretionary annual bonus program or, for field sales representatives, a sales-based incentive plan
- Stock-based long-term incentives
- Award-winning time-off plans
- Flexible work models where possible
- Career development opportunities
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
